Healthcare Provider Details

I. General information

NPI: 1396331047
Provider Name (Legal Business Name): JUAN ANDRES OHARRIZ VINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 12/16/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 AVE HOSTOS
MAYAGUEZ PR
00682-1560
US

IV. Provider business mailing address

3328 SOMERSET PARK DR
ORLANDO FL
32824-7341
US

V. Phone/Fax

Practice location:
  • Phone: 787-652-9200
  • Fax:
Mailing address:
  • Phone: 787-247-2664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: